Healthcare wayfinders use user-friendly terms such as â€˜kidneyâ€™ and â€˜blood testsâ€™ to describe the function of a department in the belief that these are easier to understand. But would further simplification and the removal of all medically-related terms improve the end usersâ€™ wayfinding ability without damaging the perception of the institution?
In healthcare environments users are expected to navigate their way through mazes of similar-looking corridors and lists of difficult medical terms that are hard to read and even more difficult to understand.
To simplify the user journey, wayfinders recommend simple user-friendly terms in the belief that these are easier to understand, to find and to express, such as â€˜kidneyâ€™ for â€˜renalâ€™ and â€˜blood testsâ€™ for â€˜phlebotomyâ€™. Some argue that there is a need for further simplification, that creating a generic address system, where the name bears no relation to the activity, such as â€˜Ward Aâ€™ or â€˜Department 2Bâ€™, would enable healthcare users to find any department without any functional understanding of what happens at that destination. After all, do users really need to understand what is going to happen during their appointment to be able to find their way? Would the removal of all medically-related terms relieve stress or do users have an intrinsic expectation of their healthcare provision tied up in its public-facing name?
From a wayfinding perspective naming is a key part of the usersâ€™ success. It creates a topology and a taxonomy generating a hierarchy that can simplify the user journey. When naming isnâ€™t considered as a key part of the wayfinding process it can also lead to confusion.
In the book Wayshowing Per Mollerup discusses the vital role that naming plays â€œNames and numbers are tools for thinking. Toponomy, the discipline of giving names to places, is grossly neglected by site owners. They donâ€™t realise how helpful good practice in this field can be to coming wayfinders. Giving names to places is often left to whimsical ideas or political caprice.â€
Whatâ€™s in a name?
If we know that names are key to successful wayfinding, then what makes for a good name and how can this best practice be translated into a healthcare environment?
As wayfinders our â€˜mantraâ€™ is consistency and clarity. Users require terms to be consistently applied across all touch points, it is no good to simply consider the names used on signs if the pre-visit information, the receptionist or the medical staff uses a different term.
During a recent project in a 600-bed general hospital the client expressed concern over users finding the â€˜X-rayâ€™ department. It was located in a prime position, yet users struggled to find it. In response the hospital had created larger signs at the departmental entrance yet this didnâ€™t seem to affect the number of users failing to find it. To understand the issues we followed users directly to the department from the main entrance and from the outpatientsâ€™ areas. It was apparent that the main issues lay with the route from â€˜Outpatientsâ€™. What we discovered was that the consultants in the â€˜Outpatientsâ€™ area were asking users to go to â€˜Radiologyâ€™ whereas the signs were labeled â€˜X-rayâ€™. No extra signage in the world could solve the inconsistenciesâ€”only communication with consultants about their role in wayfinding would cure the condition.
Users require clarity: there can be no ambiguity about terms used. Names need to be literately functional, and they need to be easy to read and to pronounce. During a project many years ago we witnessed elderly users entering the Sexual Health Clinic within a hospital looking for the Dental Department. They were lost because they didnâ€™t realise that the â€˜Orthodonticâ€™ Department was the dental department, instead they opted for the â€˜GUMâ€™ Clinic (Geo-Urinary Medicine Clinicâ€”the name for the Sexual Health Department), as â€˜GUMâ€™ was the nearest term to â€˜teethâ€™.
The argument for simplification
If users struggle with consistency and clarity, surely this is the best argument for simplification. Nevertheless, there is a case for users feeling reassured by medical terms, that this toponomy evokes feelings of professionalism, respect, andâ€”for users with long-term illnessesâ€”a deeper understanding of their condition. Healthcare provision is becoming more high-tech and users are more involved in their own clinical outcome.
However, an American study has shown that healthcare literacy rates are poorer than expected across the general population and that the economic and functional impact of this far outweighs those who appreciate the use of medical terms. This was backed-up by a European study into health literacy. Anna Webster of Health Leaders Media describes â€œWhen Joe Smith walks into a bar, chances are he isnâ€™t going to order an â€˜alcoholic libationâ€™ to quench his thirst. Heâ€™s going to order a beer. The same scenarioâ€”minus the beerâ€”applies when Joe Smith walks into a hospital or clinic for treatment.â€
Webster goes onto state â€œUnfortunately, current data indicates that more than a third of American adultsâ€”some 89 million peopleâ€”lack sufficient health literacy to effectively undertake and execute needed medical treatments and preventive health care. Inadequate health literacy affects all segments of the populationâ€
If health literacy levels are lower than expected and consistency and clarity are key to successful wayfinding then how far could we take simplification? Is it enough that the â€˜Geriatricâ€™ ward becomes â€˜Elderly Careâ€™, or could we remove all function-related references without damaging the perception of the institution and wayfinding ability of the user?
Testing the theory
At the new Royal London Hospital this has been tested. All wards over the 15-storey new hospital building have been provided with an address system. It is alpha-numeric with the ward name reflecting the floor level it is based on and a letter which provides a wayfinding cue as to its location, by the fact that â€˜12Aâ€™ would be co-located with â€˜12Bâ€™ etc. This type of address naming system is utilised in hotels, apartment blocks and classrooms the world overâ€”would it be a great stretch to apply it to a hospital environment? Fundamentally it will get users to their destination regardless of their health literacy, it will allow for changes to the function of a ward without having to change its name and it meets the requirements of clarity. It doesnâ€™t provide users with any understanding of what might happen to them when they enter the area, but equally it doesnâ€™t misrepresent this either.
Ultimately wayfinding requirements and low health literacy make a strong case for simple naming. Using alpha-numeric names does provide a useful solution. However, personally I question its â€˜institutional feelâ€™, which for me is cold and lacking in human emotion. Iâ€™d like to see a â€˜middle groundâ€™ with the use of generic names that are simple, humane and engaging, that meet wayfinding requirements and do not attempt to represent medical termsâ€”but that at the very least distract users from the unpleasant nature of hospital visits and at best provide an engaging and welcoming experience. For users to feel better, to arrive in a healthcare environment in a calmer state, we need to be considered and consistent about names used, otherwise it may make us all sick.
Mollerup, P 2005. Wayshowing: A Guide to Environmental Signage Principles and Practices
Weiss, D 2007. Removing barriers to better, safer care. Health literacy and patient safety: Help patients understand Manual for clinicians Second Edition